Provider Demographics
NPI:1275828642
Name:MYERS, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 W ADDISON ST
Mailing Address - Street 2:TARGET PHARMACY STORE NUMBER T-1437
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4635
Mailing Address - Country:US
Mailing Address - Phone:773-604-7681
Mailing Address - Fax:773-604-7681
Practice Address - Street 1:2939 W ADDISON ST
Practice Address - Street 2:TARGET PHARMACY STORE NUMBER T-1437
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4635
Practice Address - Country:US
Practice Address - Phone:773-604-7681
Practice Address - Fax:773-604-7681
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist